Exercise and Physical Activity in the Prevention and Treatment of Atherosclerotic Cardiovascular Disease: A Statement From the Council on Clinical Cardiology (Subcommittee on Exercise, Rehabilitation, and Prevention) and the Council on Nutrition, Physical Activity, and Metabolism (Subcommittee on Physical Activity)

In the paper

“Total mortality was reduced 27% (PϽ0.05) with the exercise-only intervention and 13% (PϭNS) with comprehensive rehabilitation (Table).”

What the sources say

• Supported

  The Effects of interventions section reports a 27% reduction in all-cause mortality with exercise-only rehabilitation (OR 0.73, 95% CI 0.54–0.98) and a smaller, non-significant 13% reduction with comprehensive rehabilitation (OR 0.87, 95% CI 0.71–1.05). These results support the stated significance categories, although the passage does not give exact P values. (LLM, conf=0.94)

  cites [25] 25. Jolliffe JA, Rees K, Taylor RS, et al. Exercise-based rehabilitation for coro- nary heart disease. Cochrane Database Syst Rev. 2001;(1):CD001800. source

In the paper

“This review 25 adds Ϸ4000 patients to the prior, widely cited meta-analyses of cardiac rehabilitation 23,24 and confirms that exercise-based cardiac rehabilitation reduces cardiac mortality but does not reduce the risk of recurrent myocardial infarction.”

What the sources say

• Supported

  The Discussion says this review increased the patient count from approximately 4,500 in earlier meta-analyses to 8,440—about 4,000 additional patients. The Effects of interventions section reports reduced cardiac mortality but no effect on recurrence of non-fatal myocardial infarction. (LLM, conf=0.94)

  cites [25] 25. Jolliffe JA, Rees K, Taylor RS, et al. Exercise-based rehabilitation for coro- nary heart disease. Cochrane Database Syst Rev. 2001;(1):CD001800. source
• ?Not checked — no full text of the sourcecites [23] 23. O'Connor GT, Buring JE, Yusuf S, et al. An overview of randomized trials of rehabilitation with exercise after myocardial infarction. Circulation. 1989; 80:234 -244. source
• ?Not checked — no full text of the sourcecites [24] 24. Oldridge NB, Guyatt GH, Fischer ME, et al. Cardiac rehabilitation after myocardial infarction: combined experience of randomized clinical trials. JAMA. 1988;260:945-950. source

In the paper

“All studies were published before January 1, 1999, and included 8440 patients who were primarily middle-aged, low-risk men.”

What the sources say

• Partly supported

  The Discussion reports 8,440 patients, and “Characteristics of trial participants” describes a predominantly male, middle-aged population whose studies commonly excluded people with comorbidity or heart failure. The Search methods say databases were searched through December 31, 1998, but that does not establish that every included study was published before January 1, 1999; the included-study tables list “Bell 99.” Page numbers were not available for these passages. (LLM, conf=0.88)

  cites [25] 25. Jolliffe JA, Rees K, Taylor RS, et al. Exercise-based rehabilitation for coro- nary heart disease. Cochrane Database Syst Rev. 2001;(1):CD001800. sourceExperimental — accuracy not yet measured

In the paper

“Additionally, rates of sudden cardiac death were not reduced, although only 4 exercise-only and 14 comprehensive rehabilitation trials analyzed this outcome.”

What the sources say

• Partly supported

  The Effects of interventions section reports no significant effect on sudden cardiac deaths and says that only 4 exercise-only trials and 14 comprehensive rehabilitation trials reported this outcome. The trial counts match, but 'rates were not reduced' states a stronger conclusion than the paper's finding of no statistically significant effect. (LLM, conf=0.86)

  cites [25] 25. Jolliffe JA, Rees K, Taylor RS, et al. Exercise-based rehabilitation for coro- nary heart disease. Cochrane Database Syst Rev. 2001;(1):CD001800. sourceExperimental — accuracy not yet measured

In the paper

“Cardiac mortality was reduced 31% (PϽ0.05) and 26% (PϽ0.05) for the exercise-only and comprehensive programs, respectively.”

What the sources say

• Supported

  The Effects of interventions section reports 31% and 26% reductions in total cardiac mortality for exercise-only and comprehensive rehabilitation, respectively, compared with usual care. Both reported 95% confidence intervals for the odds ratios exclude 1, consistent with P<0.05. No page number is provided in the supplied copy. (LLM, conf=0.94)

  cites [25] 25. Jolliffe JA, Rees K, Taylor RS, et al. Exercise-based rehabilitation for coro- nary heart disease. Cochrane Database Syst Rev. 2001;(1):CD001800. source

In the paper

“At least 8 studies have examined the adjunctive effect of exercise on smoking cessation, but most trials were small and the results not subjected to meta-analysis.21”

What the sources say

• Supported

  The Results (Description of studies) identify 20 eligible trials, exceeding the claimed eight. The Summary of findings (p. 3) says inadequate sample size affected a majority of studies and clinical heterogeneity precluded meta-analysis. (LLM, conf=0.94)

  cites [21] 21. Ussher MH, West R, Taylor AH, et al. Exercise interventions for smoking cessation. Cochrane Database Syst Rev. 2000;(3):CD002295. source

In the paper

“Similarly, only 5 exercise-only trials and 10 comprehensive trials examined the rate of coronary artery bypass grafting.”

What the sources say

• Supported

  The Effects of interventions section says that five exercise-only trials reported CABG as an outcome and gives a pooled CABG estimate for ten comprehensive cardiac rehabilitation trials. Those are the two counts in the claim. (LLM, conf=0.94)

  cites [25] 25. Jolliffe JA, Rees K, Taylor RS, et al. Exercise-based rehabilitation for coro- nary heart disease. Cochrane Database Syst Rev. 2001;(1):CD001800. source

In the paper

“Neither the exercise-only program nor the comprehensive intervention significantly reduced the rate of nonfatal myocardial infarction.”

What the sources say

• Supported

  The Effects of interventions section reports no effect on recurrent non-fatal myocardial infarction for either exercise-only or comprehensive cardiac rehabilitation. Both pooled confidence intervals include 1, supporting the claim that neither reduction was statistically significant. (LLM, conf=0.95)

  cites [25] 25. Jolliffe JA, Rees K, Taylor RS, et al. Exercise-based rehabilitation for coro- nary heart disease. Cochrane Database Syst Rev. 2001;(1):CD001800. source

In the paper

“In addition to improving exercise capacity, exercise training in HF patients has been shown to improve cardiac output at maximal workloads, 36 improve mitochondrial size and density, 37 increase skeletal muscle oxidative enzymes, reduce endothelial dysfunction, 38 and decrease circulating catecholamines.39”

What the sources say

• ?Not checked — no full text of the sourcecites [36] 36. Cheetham C, Green D, Collis J, et al. Effect of aerobic and resistance exercise on central hemodynamic responses in severe chronic heart failure. J Appl Physiol. 2002;93:175-180. source
• Supported

  Citation 37 is attached to the claim about mitochondrial size and density, not the other effects listed in the sentence. The Results report increased surface density of cytochrome c oxidase-positive mitochondria and increased mean surface density of a single mitochondrion after six months of exercise training in patients with chronic heart failure. The paper reports no significant change in their total number. (LLM, conf=0.91)

  cites [37] 37. Hambrecht R, Fiehn E, Yu J, et al. Effects of endurance training on mito- chondrial ultrastructure and fiber type distribution in skeletal muscle of patients with stable chronic heart failure. J Am Coll Cardiol. 1997;29: 1067-1073. source
• ?Not checked — no full text of the sourcecites [38] 38. Gielen S, Erbs S, Schuler G, et al. Exercise training and endothelial dys- function in coronary artery disease and chronic heart failure: from molecular biology to clinical benefits. Minerva Cardioangiol. 2002;50:95-106.

In the paper

“In one study, the increase in RPP at the onset of angina occurred only during exercise, 32 whereas the RPP at the onset of angina with ventricular pacing was unchanged.”

What the sources say

• Partly supported

  The Results report that RPP at the angina threshold rose after conditioning during exercise but was unchanged during pacing. The Methods identify that procedure as atrial pacing, not the ventricular pacing specified in the claim. (LLM, conf=0.88)

  cites [32] 32. Sim DN, Neill WA. Investigation of the physiological basis for increased exercise threshold for angina pectoris after physical conditioning. J Clin Invest. 1974;54:763-770. sourceExperimental — accuracy not yet measured

In the paper

“Older patients with CAD have exercise trainability comparable to that of younger patients participating in similar exercise rehabilitation, with elderly male and female patients showing comparable improvement.[45][46][47]”

What the sources say

• Partly supported

  The Abstract’s Results and Conclusions report similar improvements in exercise capacity among older and younger patients in cardiac rehabilitation, supporting the age comparison. The available passages do not report a comparison of improvement between elderly male and female patients; a search for sex-specific results found none. (LLM, conf=0.88)

  cites [45] 45. Lavie CJ, Milani RV, Littman AB. Benefits of cardiac rehabilitation and exercise training in secondary coronary prevention in the elderly. J Am Coll Cardiol. 1993;22:678 -683. sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [46] 46. Williams MA, Maresh CM, Esterbrooks DJ, et al. Early exercise training in patients older than age 65 years compared with that in younger patients after acute myocardial infarction or coronary artery bypass grafting. Am J Cardiol. 1985;55:263-266. source
• ?Not checked — no full text of the sourcecites [47] 47. Ades PA, Waldmann ML, Gillespie C. A controlled trial of exercise training in older coronary patients. J Gerontol A Biol Sci Med Sci. 1995;50A: M7-M11. source

In the paper

“Risk of injury increases with obesity, 51 volume of exercise, 50 and participation in vigorous exercise such as competitive sports, 54 whereas higher fitness, 50 supervision, stretching exercises, protective equipment such as bike helmets, and well-designed environments protect against injury.”

What the sources say

• ?Not checked — no full text of the sourcecites [50] 50. Hootman JM, Macera CA, Ainsworth BE, et al. Epidemiology of musculo- skeletal injuries among sedentary and physically active adults. Med Sci Sports Exerc. 2002;34:838 -844. source
• Partly supported

  Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

  cites [51] 51. Sutton AJ, Muir KR, Mockett S, et al. A case-control study to investigate the relation between low and moderate levels of physical activity and osteoar- thritis of the knee using data collected as part of the Allied Dunbar National Fitness Survey. Ann Rheum Dis. 2001;60:756 -764. sourceExperimental — accuracy not yet measured
• ?Not checked — no full text of the sourcecites [54] 54. Nicholl JP, Coleman P, Williams BT. The epidemiology of sports and exercise related injury in the United Kingdom. Br J Sports Med. 1995;29: 232-238. source

In the paper

“Eighty-one percent of the registrants reported increased physical activity.”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [3] 3. Wing RR, Hill JO. Successful weight loss maintenance. Annu Rev Nutr. 2001;21:323-341.

In the paper

“Average systolic and diastolic blood pressures decreased 2.6 and 1.8 mm Hg in normotensive subjects and 7.4 and 5.8 mm Hg in hypertensive subjects, respectively, suggesting that exercise may serve as the only therapy required in some mildly hypertensive subjects.”

What the sources say

• ?Not checked — no full text of the sourcecites [19] 19. Fagard RH. Exercise characteristics and the blood pressure response to dynamic physical training. Med Sci Sports Exerc. 2001;33(6 suppl): S484 -S492. source

In the paper

“Physical activity both prevents and helps treat many established atherosclerotic risk factors, including elevated blood pressure, insulin resistance and glucose intolerance, elevated triglyceride concentrations, low high-density lipoprotein cholesterol (HDL-C) concentrations, and obesity.”

In the paper

“There is also evidence that exercise reduces the risk of other chronic diseases, including type 2 diabetes, 1 osteoporosis, 2 obesity, 3 depression, 4 and cancer of the breast 5 and colon.6”

What the sources say

• ?Not checked — no full text of the sourcecites [1] 1. Knowler WC, Barrett-Connor E, Fowler SE, et al, for the Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403. source
• ?Not checked — no full text of the sourcecites [2] 2. Vuori IM. Dose-response of physical activity and low back pain, osteoar- thritis, and osteoporosis. Med Sci Sports Exerc. 2001;33(6 suppl):S551-S586. source
• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [3] 3. Wing RR, Hill JO. Successful weight loss maintenance. Annu Rev Nutr. 2001;21:323-341.

In the paper

“The results are consistent with all published studies documenting lower CAD rates in the more active subjects, although the relationship did not reach statistical significance in some individual reports.”

What the sources say

• ?Not checked — no full text of the sourcecites [9] 9. Lee IM, Paffenbarger RS Jr, Hennekens CH. Physical activity, physical fitness and longevity. Aging (Milano). 1997;9:2-11. source
• ?Not checked — no full text of the sourcecites [10] 10. Blair SN, Jackson AS. Physical fitness and activity as separate heart disease risk factors: a meta-analysis. Med Sci Sports Exerc. 2001;33:762-764. source

In the paper

“A meta-analysis of 52 exercise training trials of Ͼ12 weeks' duration including 4700 subjects demonstrated an average increase in HDL-C levels of 4.6% and reductions in triglyceride and LDL-C concentrations of 3.7% and 5.0%, respectively.15,16”

What the sources say

• ?Not checked — no full text of the sourcecites [15] 15. Leon AS, Sanchez OA. Response of blood lipids to exercise training alone or combined with dietary intervention. Med Sci Sports Exerc. 2001;33(6 suppl): S502-S515. source
• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [16] 16. Leon AS, Sanchez O. Meta-analysis of the effects of aerobic exercise training on blood lipids. Circulation. 2001;104(suppl II):II-414 -II-415. Abstract.

In the paper

“Physical activity also reduces insulin resistance and glucose intolerance, postprandial hyperglycemia, and possibly hepatic glucose output.20”

What the sources say

• ?Not checked — no full text of the sourcecites [20] 20. Thompson PD, Crouse SF, Goodpaster B, et al. The acute versus the chronic response to exercise. Med Sci Sports Exerc. 2001;33(6 suppl):S438 -S445. source

In the paper

“Exercise in combination with weight reduction can decrease low-density lipoprotein cholesterol (LDL-C) concentrations and limit the reduction in HDL-C that often occurs with a reduction in dietary saturated fat.14”

What the sources say

• ?Not checked — no full text of the sourcecites [14] 14. Stefanick ML, Mackey S, Sheehan M, et al. Effects of diet and exercise in men and postmenopausal women with low levels of HDL cholesterol and high levels of LDL cholesterol. N Engl J Med. 1998;339:12-20. source

In the paper

“HDL-C among the 376 women increased 1.4 mg/dL (3%), and triglycerides and LDL-C decreased 0.6 and 4.4 mg/dL or 0.6% and 4%, respectively.”

What the sources say

• ?Not checked — no full text of the sourcecites [17] 17. Leon AS, Rice T, Mandel S, et al. Blood lipid response to 20 weeks of supervised exercise in a large biracial population: the HERITAGE Family Study. Metabolism. 2000;49:513-520. source

In the paper

“The lifestyle intervention was also significantly more powerful than metformin (850 mg BID), which reduced the onset of type II diabetes by 31%.”

What the sources say

• ?Not checked — no full text of the sourcecites [1] 1. Knowler WC, Barrett-Connor E, Fowler SE, et al, for the Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002;346:393-403. source

In the paper

“HDL-C increased 1.1 mg/dL (3%) among the 299 men studied, whereas triglycerides and LDL-C decreased 5.9 and 0.9 mg/dL or 2.7% and 0.8%, respectively.”

What the sources say

• ?Not checked — no full text of the sourcecites [17] 17. Leon AS, Rice T, Mandel S, et al. Blood lipid response to 20 weeks of supervised exercise in a large biracial population: the HERITAGE Family Study. Metabolism. 2000;49:513-520. source

In the paper

“Furthermore, during 33Ϯ7 months of follow-up, the exercise-trained patients had fewer cardiac events (11.9% versus 32.2%) and hospital readmissions (18.6% versus 46%) than subjects assigned to usual care.”

What the sources say

• ?Not checked — no full text of the sourcecites [34] 34. Belardinelli R, Paolini I, Cianci G, et al. Exercise training intervention after coronary angioplasty: the ETICA trial. J Am Coll Cardiol. 2001;37: 1891-1900. source

In the paper

“Residual coronary stenosis and recurrent cardiac events were reduced by 30% and 29%, respectively, in the trained subjects.”

What the sources say

• ?Not checked — no full text of the sourcecites [34] 34. Belardinelli R, Paolini I, Cianci G, et al. Exercise training intervention after coronary angioplasty: the ETICA trial. J Am Coll Cardiol. 2001;37: 1891-1900. source

In the paper

“No large studies have directly addressed the utility of exercise in this group, although there are encouraging data.”

In the paper

“Vigorous exercise also acutely reduces systolic blood pressure, and this effect may persist for up to 12 hours.20”

What the sources say

• ?Not checked — no full text of the sourcecites [20] 20. Thompson PD, Crouse SF, Goodpaster B, et al. The acute versus the chronic response to exercise. Med Sci Sports Exerc. 2001;33(6 suppl):S438 -S445. source

In the paper

“Angiographic restenosis was not affected by exercise training, but trained patients demonstrated significant increases in peak V ˙O2 (26%) and quality-of-life parameters (27%).”

What the sources say

• ?Not checked — no full text of the sourcecites [34] 34. Belardinelli R, Paolini I, Cianci G, et al. Exercise training intervention after coronary angioplasty: the ETICA trial. J Am Coll Cardiol. 2001;37: 1891-1900. source

In the paper

“Numerous trials have demonstrated that both exercise testing and training of patients with HF appear to be safe.”

In the paper

“In a cohort study of community adults aged 20 to 85 years with above-average activity levels, Ϸ25% reported a musculoskeletal injury over 1 year, 50 and one third of injured adults stopped exercising.”

What the sources say

• ?Not checked — no full text of the sourcecites [50] 50. Hootman JM, Macera CA, Ainsworth BE, et al. Epidemiology of musculo- skeletal injuries among sedentary and physically active adults. Med Sci Sports Exerc. 2002;34:838 -844. source

In the paper

“In contrast, a direct comparison of invasive treatment and supervised exercise training found improvement at 1 year only in the invasively treated patients, 44 so the issue remains controversial.”

What the sources say

• ?Not checked — no full text of the sourcecites [44] 44. Gelin J, Jivegard L, Taft C, et al. Treatment efficacy of intermittent claudi- cation by surgical intervention, supervised physical exercise training compared to no treatment in unselected randomised patients: I. one year results of functional and physiological improvements. Eur J Vasc Endovasc Surg. 2001;22:107-113. source

In the paper

“The greatest improvement with exercise training for claudication occurred with training to maximal tolerated pain, when training lasted at least 6 months, and when walking was the primary mode of exercise.42”

What the sources say

• ?Not checked — no full text of the sourcecites [42] 42. Gardner AW, Poehlman ET. Exercise rehabilitation programs for the treatment of claudication pain: a meta-analysis. JAMA. 1995;274:975-980. source

In the paper

“In general, the effect of exercise on atherosclerotic risk factors is substantially less than that achieved by pharmacological therapies, although the exercise effect can be significantly magnified by other lifestyle changes such as changes in dietary composition and weight loss.”

In the paper

“There was no relationship between the weekly training frequency, time per session, or intensity of exercise training and the magnitude of the blood pressure reduction, which suggests that the dose-response curve for exercise and blood pressure is flat.”

What the sources say

• ?Not checked — no full text of the sourcecites [19] 19. Fagard RH. Exercise characteristics and the blood pressure response to dynamic physical training. Med Sci Sports Exerc. 2001;33(6 suppl): S484 -S492. source

In the paper

“Habitual physical activity also prevents the development of coronary artery disease (CAD) and reduces symptoms in patients with established cardiovascular disease.”

In the paper

“Greater increases in HDL-C may occur in individuals with baseline hypertriglyceridemia, 18 but few studies have addressed the effect of exercise in subjects with lipid disorders.”

What the sources say

• ?Not checked — no full text of the sourcecites [18] 18. Couillard C, Despres JP, Lamarche B, et al. Effects of endurance exercise training on plasma HDL cholesterol levels depend on levels of triglycerides: evidence from men of the Health, Risk Factors, Exercise Training and Genetics (HERITAGE) Family Study. Arterioscler Thromb Vasc Biol. 2001; 21:1226 -1232. source

In the paper

“The effect on atherosclerotic risk factors can be large in some individuals and obviate the need for other interventions.”

In the paper

“Some subsequent reports also demonstrated an increase in the RPP at the onset of angina as well as a reduction in the ischemic response measured as angina, ST-segment depression, 29 or nuclear and positron-emission tomography scanning perfusion defects 30,31 at a given RPP, which suggests that exercise training improved myocardial oxygen delivery.”

What the sources say

• ?Not checked — no full text of the sourcecites [29] 29. Ehsani AA, Martin WH 3rd, Heath GW, et al. Cardiac effects of prolonged and intense exercise training in patients with coronary artery disease. Am J Cardiol. 1982;50:246 -254. source
• ?Not checked — no full text of the sourcecites [30] 30. Niebauer J, Hambrecht R, Velich T, et al. Attenuated progression of coronary artery disease after 6 years of multifactorial risk intervention: role of physical exercise. Circulation. 1997;96:2534 -2541. source
• ?Not checked — no full text of the sourcecites [31] 31. Gould KL, Ornish D, Kirkeeide R, et al. Improved stenosis geometry by quantitative coronary arteriography after vigorous risk factor modification. Am J Cardiol. 1992;69:845-853. source

In the paper

“These acute effects provide additional support for the recommendations from the CDC and the ACSM that adults should participate in moderate-intensity physical activity on most, if not all, days of the week.7”

What the sources say

• ?Not checked — no full text of the sourcecites [7] 7. Pate RR, Pratt M, Blair SN, et al. Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995;273:402-407. source

In the paper

“Similarly, the effects of medical treatment may be overestimated in medical intervention trials not involving exercise.”

In the paper

“The reduction in death without a reduction in nonfatal reinfarction raises the possibility that exercise training enhanced electrical stability and reduced ventricular fibrillation 26 or reduced myocardial damage directly or via such factors as ischemic preconditioning.27”

What the sources say

• ?Not checked — no full text of the sourcecites [26] 26. Billman GE. Aerobic exercise conditioning: a nonpharmacological antiar- rhythmic intervention. J Appl Physiol. 2002;92:446 -454. source
• ?Not checked — no full text of the sourcecites [27] 27. Hamilton KL, Powers SK, Sugiura T, et al. Short-term exercise training can improve myocardial tolerance to I/R without elevation in heat shock proteins. Am J Physiol Heart Circ Physiol. 2001;281:H1346 -H1352. source

In the paper

“Whether these physiological adaptations will ultimately reduce mortality and morbidity is yet to be determined by a large prospective trial, although there is at least one small trial which showed a reduction in hospitalizations and improved 1-year survival.41”

What the sources say

• ?Not checked — no full text of the sourcecites [41] 41. Belardinelli R, Georgiou D, Cianci G, et al. Randomized, controlled trial of long-term moderate exercise training in chronic heart failure: effects on functional capacity, quality of life, and clinical outcome. Circulation. 1999; 99:1173-1182. source

In the paper

“A preliminary report from a 3-million-member national fitness facility noted 61 male and 10 female deaths over 2 years and calculated incidence rate of 1 death per 82 000 members per year or 2.6 million workouts.63”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [63] 63. Franklin BA, Conviser JM, Stewart B, et al. Sporadic exercise: a trigger for acute cardiovascular events? Circulation. 2000;102(suppl II):II-612. Abstract.

In the paper

“Indeed, the original AHA Statement on Exercise in 1992 66 was among the first documents to conclude that physical inactivity is a major CAD risk factor.”

What the sources say

• ?Not checked — no full text of the sourcecites [66] 66. Fletcher GF, Balady G, Blair SN, et al. Statement on exercise: benefits and recommendations for physical activity programs for all Americans. A statement for health professionals by the Committee on Exercise and Cardiac Rehabilitation of the Council on Clinical Cardiology, American Heart Asso- ciation. Circulation. 1996;94:857-862. source

In the paper

“In some situations, regular physical activity actually reduces injury risk, as indicated by a recent consensus statement that physical activity is recommended to reduce the risk of fall injuries in older adults.55”

What the sources say

• ?Not checked — no full text of the sourcecites [55] 55. Guideline for the prevention of falls in older persons. American Geriatrics Society, British Geriatrics Society, and American Academy of Orthopaedic Surgeons Panel on Falls Prevention. J Am Geriatr Soc. 2001;49:664 -672. source

In the paper

“The 6 strategies deemed effective were: (1) large-scale, intense, highly visible, community-wide campaigns; (2) point-ofdecision prompts that encourage people to use the stairs instead of elevators or escalators; (3) physical education programs in schools; (4) social support programs (such as buddy systems and walking groups); (5) individually adapted behavior change programs; and (6) enhanced”

What the sources say

• ?Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

  cites [71] 71. Increasing physical activity: a report on recommendations of the Task Force on Community Preventive Services. MMWR Recomm Rep. October 26, 2001;50(RR-18):1-14.

In the paper

“Physical activity and exercise training have important roles in: A. Preventing atherosclerotic CAD; B. Managing selected CAD risk factors, including elevated triglyceride levels, low HDL-C, hypertension, glucose intolerance, hypertension, obesity, and possibly cigarette use; C. Treating patients with CAD, HF, and claudication.”

In the paper

“The general principle that the volume of physical activity should be increased gradually over time is widely regarded as critical for reducing injury risk.7”

What the sources say

• ?Not checked — no full text of the sourcecites [7] 7. Pate RR, Pratt M, Blair SN, et al. Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA. 1995;273:402-407. source